Malignant obstruction develops frequently in advanced gastric cancer. Although it is primarily the gastric outlet that is obstructed, there are occasional reports of colonic obstruction. Treating intestinal obstruction usually requires emergency surgery or stent insertion. There are several kinds of complications with stent insertion, such as bowel perforation, stent migration, bleeding, abdominal pain and reobstruction. Nevertheless, endoscopic stent insertion could be a better treatment than emergency surgery in cases of malignant bowel obstruction in cancer patients with poor performance status. We report a case of advanced gastric cancer with carcinomatosis in which a recurrent colonic stent was inserted at the same site because of cancer growth into the stent. The patient maintained a good condition for chemotherapy, thus improving their chances for survival.
Aged ; Female ; Humans ; Intestinal Obstruction/etiology/radiography/*surgery ; Neoplasm Recurrence, Local ; Prosthesis Implantation/*methods ; *Stents ; Stomach Neoplasms

ProSeal(TM) laryngeal mask airway (PLMA) was developed to be more effective especially with glottic airway sealing and is suppose to be an improved device over the classic laryngeal mask airway (cLMA). The PLMA's cuff is bulkier, softer, and more pliable than the cLMA. We reviewed a case were a patient had hand surgery under general anesthesia using the PLMA. After having the hand surgery, the patient suffered from dyspnea and had difficulty with their respirations at a supine position. The problems with dyspnea and respiration after surgery resulted because of difficulties from inserting PLMA No.5 into the patient. We suspect from this case that the problems in dyspnea and respiration were due to the folded cuff and incomplete placement of the PLMA, which resulted in lacerations of the mucosa in the soft palate of the patient. In this paper, we considered the probable causes for lacerations of the mucosa in the soft palate and reviewed all of the relevant literature, especially about the proper placement of the PLMA.
Anesthesia, General ; Dyspnea ; Hand ; Humans ; Lacerations ; Laryngeal Masks ; Mucous Membrane ; Palate, Soft ; Respiration ; Supine Position

PURPOSE: A decline in the circulating levels of estrogen impairs vaginal engorgement, which leads to histopathological changes in the vaginal tissues. The aim of this study was to evaluate the effect of delayed estrogen replacement on the vagina structure in castrated rabbits. Materials and Methods: New Zealand White female rabbits were randomly divided into three groups; two groups (the castration and castration estrogen replacement groups) were castrated: the control group underwent sham operations. Nine weeks after surgery, the estrogen replacement group received subcutaneous injections of estrogen (50microgram/kg/day) for 4 weeks. Vaginal tissue was processed for histology with Masson's trichome stain. The expressions of e-NOS and n-NOS were examined by immunohistochemistry and Western blot. RESULTS: From the histology, marked thinning of the vaginal epithelial layers, and decreased smooth muscle content and submucosal microvasculatures were evident, but with no increase in the collagen fibers in the castrated group was noted. The vaginal tissue of the estrogen replaced animal showed similar morphological features to those in the control rabbits. From the histomorphometry, the percentage of vaginal smooth muscle in the castrated group was significantly decreased compared to those in the control and estrogen replaced groups. The expression and signal intensity of e-NOS were decreased in the vagina of the castrated animals compare to those in the control group. In the estrogen replaced group, the expression of e-NOS was normalized. CONCLUSIONS: Delayed estrogen replacement showed structural restoration of vaginal tissues. These results suggest that delayed estrogen replacement therapy could improve the sexual function in menopausal women.
Animals ; Blotting, Western ; Castration ; Collagen ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Humans ; Immunohistochemistry ; Injections, Subcutaneous ; Menopause ; Muscle, Smooth ; New Zealand ; Rabbits ; Trichomes ; Vagina

PURPOSE: The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear. One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established. The aim of this study was to evaluate the efficacy of cytology using samples harvested from two different abdominal cavity sites during gastric cancer surgery. MATERIALS AND METHODS: We prospectively recruited 108 patients who were clinically diagnosed with locally advanced gastric cancer (higher than cT1 stage disease). Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area. Patients were prospectively followed up for 2 years to determine the recurrence and survival rates. RESULTS: Thirty-three patients dropped out of the study for various reasons, so 75 patients were included in the final analysis. Seven patients (9.3%) showed positive cytology findings, of whom, three showed peritoneal recurrence. Tumor size was the only factor associated with positive cytology findings (P=0.037). The accuracy and specificity of cytology for predicting peritoneal recurrence were 90.1% and 94.2%, respectively, whereas the sensitivity was 50.0%. The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings (P=0.081). CONCLUSIONS: Peritoneal washing cytology using samples harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients. Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure.
Abdominal Cavity ; Humans ; Neoplasm Metastasis ; Peritoneum ; Prospective Studies* ; Recurrence* ; Sensitivity and Specificity ; Stomach Neoplasms* ; Survival Rate

No abstract available.
Granuloma, Plasma Cell* ; Histiocytic Sarcoma*

PURPOSE: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. MATERIALS AND METHODS: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. RESULTS: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). CONCLUSIONS: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).
Bile ; Bile Reflux ; Gastrectomy* ; Gastric Stump ; Gastritis ; Hand ; Humans ; Methods ; Prospective Studies ; Stomach Neoplasms*

BACKGROUND: It was reported that patients who have left ventricular hypertrophy have higher D allele frequency of angiotensin I-converting enzyme gene polymorphism, especially in Caucasian normotensive men. We studied to know whether genetic polymorphism of angiotensin I-converting enzyme gene is associated with the development of left ventricular hypertrophy in Korean people whose genotype frequency is quite different from that of Caucasians. METHODS: Total 156 patients were included in this study. Presence of hypertension was checked with the criteria that hypertensives are one whose blood pressures were all above 140/90 at least 3 times spanning 2 months or one who had been diagnosed as hypertension and on his medication. Left ventricular mass index(LVMI) was calculated using electrocardiogram by Rautaharju equation, and left ventricular hypertrophy(LVH) was defined as LVMI was above 131g/m2 in male or above 110g/m2 in female. Genomic DNA was extracted from the mononuclear cell of each subjects and PCR was performed using new primers for the region of intron 16 and exon 17. RESULTS: Genotype frequencies of D/D genotype and D allele were 0.200 and 0.413 respectively in group with LVH(n=40), 0.103 and 0.392 respectively in group without LVH(n=116). There was no significant difference with each other group. However, when only the normotensives were included in this analysis, frequency of D/D genotype is significantly higher in group with LVH(0.231, n=26) than in group without LVH(0.076, n=79)(Fisher's exact test,p<0.05). There was no significant difference in genotype frequency between the normotensives(n=105) and the hypertensives(n=51). CONCLUSIONS: In Korean people, D allele of polymorphism of angiotensin I-converting enzyme gene is also associated with development of left ventricular hypertrophy in the normotensives and is not associated with essential hypertension.
Alleles ; Angiotensins* ; DNA ; Electrocardiography ; Exons ; Female ; Gene Frequency ; Genotype ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Introns ; Male ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Polymorphism, Genetic

BACKGROUND: It was reported that patients who have left ventricular hypertrophy have higher D allele frequency of angiotensin I-converting enzyme gene polymorphism, especially in Caucasian normotensive men. We studied to know whether genetic polymorphism of angiotensin I-converting enzyme gene is associated with the development of left ventricular hypertrophy in Korean people whose genotype frequency is quite different from that of Caucasians. METHODS: Total 156 patients were included in this study. Presence of hypertension was checked with the criteria that hypertensives are one whose blood pressures were all above 140/90 at least 3 times spanning 2 months or one who had been diagnosed as hypertension and on his medication. Left ventricular mass index(LVMI) was calculated using electrocardiogram by Rautaharju equation, and left ventricular hypertrophy(LVH) was defined as LVMI was above 131g/m2 in male or above 110g/m2 in female. Genomic DNA was extracted from the mononuclear cell of each subjects and PCR was performed using new primers for the region of intron 16 and exon 17. RESULTS: Genotype frequencies of D/D genotype and D allele were 0.200 and 0.413 respectively in group with LVH(n=40), 0.103 and 0.392 respectively in group without LVH(n=116). There was no significant difference with each other group. However, when only the normotensives were included in this analysis, frequency of D/D genotype is significantly higher in group with LVH(0.231, n=26) than in group without LVH(0.076, n=79)(Fisher's exact test,p<0.05). There was no significant difference in genotype frequency between the normotensives(n=105) and the hypertensives(n=51). CONCLUSIONS: In Korean people, D allele of polymorphism of angiotensin I-converting enzyme gene is also associated with development of left ventricular hypertrophy in the normotensives and is not associated with essential hypertension.
Alleles ; Angiotensins* ; DNA ; Electrocardiography ; Exons ; Female ; Gene Frequency ; Genotype ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Introns ; Male ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Polymorphism, Genetic

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been widely used as a treatment for the movement disturbances caused by Parkinson's disease (PD). Despite successful application of DBS, its mechanism of therapeutic effect is not clearly understood. Because PD results from the degeneration of dopamine neurons that affect the basal ganglia (BG) network, investigation of neuronal responses of BG neurons during STN DBS can provide informative insights for the understanding of the mechanism of therapeutic effect. However, it is difficult to observe neuronal activity during DBS because of large stimulation artifacts. Here, we report the observation of neuronal activities of the globus pallidus (GP) in normal and PD model rats during electrical stimulation of the STN. A custom artifact removal technique was devised to enable monitoring of neural activity during stimulation. We investigated how GP neurons responded to STN stimulation at various stimulation frequencies (10, 50, 90 and 130 Hz). It was observed that activities of GP neurons were modulated by stimulation frequency of the STN and significantly inhibited by high frequency stimulation above 50 Hz. These findings suggest that GP neuronal activity is effectively modulated by STN stimulation and strongly dependent on the frequency of stimulation.
Animals ; Artifacts ; Basal Ganglia ; Deep Brain Stimulation ; Dopamine ; Electric Stimulation ; Globus Pallidus ; Neurons ; Parkinson Disease ; Rats ; Subthalamic Nucleus

PURPOSE: The rate of second primary lung cancer development for patients with head and neck cancer (HNC) has been noted. The aim of our study was to evaluate the incidence and clinical features of suspected second primary lung cancer that developed in patients with primary HNC. MATERIALS AND METHODS: We conducted a retrospective study of 469 patients who were newly diagnosed with HNC at the Korea University Medical Center between January 2000 and December 2006. RESULTS: A total of 469 patients were included (389 men and 80 women). Eighteen patients (3.8%) had suspected second primary lung cancers. Statistically significant clinical variables for lung cancer development included the origin site for the primary HNC (oro-hypopharynx and larynx) (p=0.048), abnormal chest x-ray findings (p=0.027) and the histological HNC type (squamous cell carcinoma) (p=0.032). When the second primary lung cancers were combined with HNCs, the adjusted overall survival of patients with a second primary lung cancer was 16 months (p<0.001). CONCLUSIONS: Considering the relative risk factors for a second primary lung cancer developing in patients with HNC, advanced diagnostic tools, such as chest CT or PET CT scan, should be applied for the early detection of a second primary lung cancer.
Academic Medical Centers ; Head ; Head and Neck Neoplasms ; Humans ; Incidence ; Korea ; Lung ; Lung Neoplasms ; Male ; Neoplasms, Second Primary ; Retrospective Studies ; Risk Factors ; Thorax